The patient came to the clinic 24-June-2012 complaining of numbness big toe left foot for one month with left sciatica.

MRI lumbar spine performed 20-June-2012 showing left far-lateral extrusion L4-5 disc.

On examination, the patient now is not limping with exaggerated scoliotic stance. SLRS was 80 degrees in the left with pain. There is weak dorsiflexion left foot 3/5 and hypalgesia left L5 territory.

The patient was advised to keep in conservative treatment, but his sciatica increases for what MRI lumbar spine repeated 08-July-2012 confirming the persistence of the extrusion.

Left L5 foraminotomy with reflection of the L4-5 ligamentum flavum to the right. The left L5 root was inspected and exploration of the far-left area revealed minor changes. Discectomy of L4-5 from the left. Further exploration with identification of the left L4 root was done with no big convincing piece. Considering that the patient has lumbarization of the sacrum, inspection the left far-lateral area of the L5-S1 revealed a big piece extruding from the annulus fibrosis, which was removed in one big piece. All stages of surgery were done under the image-guided control. The ligamentum flavum was preserved at both levels. Guardix-sol was applied to decrease the postoperative adhesions.

Routine closure of the wound. Smooth postoperative recovery. The power of right foot became better.

Do not ever trust the radiologic reports. You must use only your eyes in interpretation the morphological picture of the the patient. In case of conflicts redo another MRI to avoid such mishap.

The patient still has an estimated postoperative recurrence about 7%, because the disc space is still not shallow.

The patient did MRI twice and the radiologists in both investigations did not notice the far-lateral extrusion in their report, even they did not included the sagittal study to cover the far-lateral aspect of the vertebral body. The last one even did not included the reference thumbnail to confirm the level of the far-lateral extrusion. In the last MRI the L4-5 was severely involved and the L5-S1 was more or less more normal. This conflict of data and bad interpretation of the radiologists led to this misinterpretation.

The guising of surgeon about the dimensions of the extrusion could only resolve the problem, so as not to miss the real huge compression.